Dural and Multiple Brain Metastases From Basaloid Nasopharyngeal Carcinoma: Case Report and Literature Review

Abstract

BackgroundNasopharyngeal carcinoma is an endemic head and neck cancer in Southern China. The common metastases organs involve bone, lung, and liver. Metastases in the dura and at multiple locations in the brain after a diagnosis of nasopharyngeal carcinoma are extremely rare.Case PresentationWe present a case of a 66-year-old man who initially complained of nasal congestion, epistaxis, and hearing impairment. The biopsy of the nasopharynx lesion showed basaloid squamous cell carcinoma. Eight months after conventional therapy, the patient was admitted to our hospital again with the complaint of a headache. A PET/CT scan was performed, revealing multiple metastases. A biopsy of subcutaneous soft tissue from the right upper arm was consistent with the previous biopsy. Palliative chemotherapy was administered. Thereafter, the patient had sudden dysfunction of the right side of the body. MRI demonstrated dural and multiple brain metastases. The therapeutic regimen then consisted of whole-brain radiotherapy, anti-angiogenesis therapy, and immunotherapy.ConclusionsThis case highlights the diagnosis and treatment of uncommon metastases of nasopharyngeal carcinoma. Clinicians should remain vigilant for metastases during the treatment and follow-up periods.

Complete response with combined therapy in a patient with brain metastasis from nasopharyngeal carcinoma: case report and literature review

“…Although solid lesions were the main morphology of NPC brain metastases in previous reports, cystic lesions are not rare. 4 , 5 , 7 , 10 – 12 It is difficult to distinguish radiation encephalopathy (RE) and metastasis by conventional MRI because cystic necrosis is a form of RE, 4 similar to the characteristics of cystic brain metastasis. Therefore, when an NPC patient presents with cystic RE in the radiation field, brain metastasis should be considered a differential diagnosis.…”

“…Distant metastasis is the main treatment failure in NPC; however, metastasis to the brain is extremely rare, ranging from an incidence of 0.3% to 0.7% in previous reports. 7,8 A PubMed search of cases of brain metastasis from NPC in the last 20 years is summarized in Table 1. 4,5,7,[9][10][11][12] It is generally acknowledged that lymphatic and hematogenous spread are the main routes of NPC metastasis.…”

“…7,8 A PubMed search of cases of brain metastasis from NPC in the last 20 years is summarized in Table 1. 4,5,7,[9][10][11][12] It is generally acknowledged that lymphatic and hematogenous spread are the main routes of NPC metastasis. 11 Tumor cell spread frequently occurs hematogenously via the circulatory system, primarily to the liver, lung, and bone.…”

Leptomeningeal metastasis from de novo metastatic nasopharyngeal carcinoma: a case report

“…The most common solid tumors are lung cancer, breast cancer, and melanoma ( 8 ). Though several studies reported multiple brain metastasis from NPC ( 9 - 11 ), there were rare reports of LM from NPC. To the best of our knowledge, our report demonstrates the first case LM from de novo metastatic NPC who was treated with initial ICI treatment combined with chemoradiotherapy.…”

Clinical characteristics and prognostic factors in nasopharyngeal carcinoma with brain metastasis: A retrospective, single‐center study

“…A search of the PubMed database within the available English literature uncovered a limited number of welldescribed cases of brain metastasis in NPC, and no studies have systematically explored the treatment and prognosis of this condition. [9][10][11][12][13][14] Therefore, we screened patients with brain metastasis from a large population using an NPC-specific dataset, aiming to improve the management of this particular subset by investigating the clinicopathological characteristics, treatment modalities, and prognostic factors.…”